Analysis Of The Efficacy Of Argon Plasma Coagulation For Hemorrhagic Chronic Radiation Proctitis

Objective:Hemorrhagic chronic radiation proctitis(HCRP)is one of the complications of radiotherapy for pelvic malignancies.The efficacy of argon plasma coagulation(APC)in the treatment of HCRP of varying severity is still unclear.The purpose of this study was to retrospectively analyze the efficacy and safety of APC in patients with HCRP of different severity.Methods:Patients with HCRP who received APC therapy at Shanxi Province Cancer Hospital from January 2017 to June 2021 were collected and analyzed.The severity of HCRP was assessed using the Zinicola endoscopic score and the Vienna rectoscopy score.The severity of HCRP was assessed using the Zinicola endoscopic score and the Vienna rectoscopy score.The changes of symptoms,endoscopic score,and hemoglobin level in HCRP patients before and after APC therapy were recorded and analyzed.The elimination of occasional bloody stools or rectal bleeding that did not require further treatment within six months of the last APC therapy was considered therapeutic success.Results:A total of 36 HCRP patients were included,and the median follow-up time was1.63 years(0.85-2.68 years).There were 16 patients(44.4%)with mild to moderate HCRP,and 20 patients(55.6%)with severe HCRP,according to the Zinicola endoscopic score.The average Zinicola endoscopic scores of mild to moderate,severe and all HCRP patients before APC therapy were 2.88±0.34 points,4.20±0.41 points and 3.61±0.77 points,and the average Vienna rectoscopy scores were 3.13±0.34 points and 4.25±0.64 points,respectively and 3.75±0.77 points,the mean hemoglobin levels were 9.52±1.50 g/d L,7.64±0.87 g/d L and 8.48±1.51 g/d L,respectively.Rectal bleeding stopped after APC therapy in patients with all mild to moderate HCRP.Sixteen(80%)patients with severe HCRP were successfully treated with APC,and four(20%)patients with severe HCRP still experienced symptoms of rectal bleeding after multiple APC therapies.Compared with before APC therapy,mild and moderate HCRP(0.50 vs 2.88 points,difference 95% confidence interval [CI]: 2.045-2.705,t value = 15.344,P<0.001)and severe HCRP(2.05 vs 4.20 points,difference 95% CI:1.875-2.425,t value=16.376,P<0.001)after APC therapy,the average Zinicola endoscopic score of the patients was significantly improved,and the difference was statistically significant.Likewise,mild to moderate HCRP(0.63 vs 3.13 points,difference 95% CI: 2.163-2.837,t value=15.811,P<0.001)and severe HCRP(1.65 vs4.25 points,difference 95% CI: 2.160-3.040,t value=12.365,P<0.001)after APC therapy,the average Vienna rectoscopy score was significantly improved,and the difference was statistically significant.The mean Zinicola endoscopy score(1.36 vs3.61 points,difference 95% CI: 2.046-2.454,t value=22.367,P<0.001)and mean Vienna rectoscopy score(1.19 vs 3.75 points,difference 95% CI: 2.282-2.829,t value=18.961,P<0.001)all have different degrees of improvement,and the difference is statistically significant.Mild to moderate HCRP(12.10 vs 9.52 g/d L,difference 95%CI: 2.160-3.002,t value = 13.068,P<0.001)and severe HCRP(10.07 vs 7.64 g/d L,difference 95% CI: 2.013-2.847,t value=12.206,P<0.001)patients had significantly improved hemoglobin levels after APC therapy,and the difference was statistically significant.The average hemoglobin level of all HCRP patients after APC therapy was 10.97±1.71g/d L,and the mean increase in hemoglobin was 2.49 g/d L(difference95% CI: 2.213-2.781,t value=17.861,P<0.001).In univariate analysis,previous blood transfusion history,lower hemoglobin level,higher Zinicola endoscopic score,and Vienna rectoscopy score,and more times of treatment were related risk factors for APC therapy failure(all P<0.05),and these risk factors were strongly correlated with APC therapy failure(Spearman rank correlation coefficient r>0.5,all P<0.05).No severe complications of stricture,perforation,or fistula related to APC therapy were observed.Conclusion:APC therapy can effectively improve the rectal bleeding symptoms,endoscopic score,and hemoglobin level of HCRP,and it is effective for mild to moderate and severe HCRP patients.APC therapy may be an effective and safe treatment option for HCRP patients.In the future,prospective randomized controlled trials should be conducted to further clarify the effect of APC in the treatment of HCRP.